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Meta-Analysis
. 2023 May;143(5):2417-2428.
doi: 10.1007/s00402-022-04438-w. Epub 2022 Apr 25.

Indications for surgical fixation of low-energy pelvic ring fractures in elderly: a systematic review

R A Timmer  1 , S M Verhage  2 , P Krijnen  3 , S A G Meylaerts  2 , I B Schipper  3
Affiliations
Meta-Analysis

Indications for surgical fixation of low-energy pelvic ring fractures in elderly: a systematic review

R A Timmer et al. Arch Orthop Trauma Surg. 2023 May.

Abstract

Introduction: There are no generally accepted criteria for when and how to fixate osteoporotic pelvic ring fractures in elderly. This systemic review aims to summarize the currently available literature regarding the indications and methods for surgical fixation of fragility fractures of the pelvic ring in elderly patients after low-energy trauma.

Materials and methods: The Pubmed and Embase databases were searched using the key words pelvic fractures, geriatric, fragility, osteoporosis, and surgical fixation, and their synonyms. Extracted data including the indication, method of operative fixation, and post-operative outcomes (pain levels, mobility, complications and mortality) were analyzed using descriptive statistics. The studies were too heterogeneous to perform a meta-analysis.

Results: Eleven cohort studies (3 comparative and 8 noncomparative) were included. The methodological quality was poor to moderate; the studies were heterogeneous regarding study design and reported outcomes. In all included studies operative treatment for all fracture types was preceded by a period of conservative treatment comprising physiotherapy-guided full weight-bearing. Time to surgery differed widely. For posterior ring fixation, the majority of the included studies used minimally invasive surgery with trans-iliosacral screws. Five studies described a form of additional fixation of the anterior pelvic ring but did not report the indications.

Conclusions: Fixation of low-energy pelvic ring fractures in elderly is commonly performed after a period of conservative treatment, with persistent pain as the most frequent indication for fixation. Fracture classification based on stability seems to be of secondary importance. Timing for surgical fixation of the pelvic ring fracture in elderly patients remains diverse. Large well-designed comparative prospective studies and randomized controlled trials are needed to provide clearly substantiated guidelines.

Keywords: Fragility; Geriatric; Indication; Osteoporosis; Pelvic fractures; Surgical fixation.

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Conflict of interest statement

The authors have no conflict of interests to declare that are relevant to the content of this article.

Figures

Fig. 1
Fig. 1
PRISMA 2009 flow diagram
See this image and copyright information in PMC

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